[ENT] Tonsillitis Flashcards

1
Q

80% of pharyngitis cases are caused by?

A

viruses and are self-limiting

e.g. flu viruses, rhinovirus, coronavirus, RSV, EBV

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2
Q

20% of pharyngitis cases are caused by?

A

bacteria and may require abx

e.g. group A/C/G strep, mycoplasma, chlamydia and gonorrhoea

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3
Q

what are the features of infectious mononucleosis?

A
  • fever
  • wt loss
  • maculopapular rash
  • hepatosplenomegaly
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4
Q

how does mild acute tonsillitis present?

A
  • freely tolerates fluids

- not clinically unwell

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5
Q

how is mild acute tonsillitis assessed?

A
  • hx + exam

- Centor / FeverPAIN score (for abx guidance)

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6
Q

how do you manage mild acute tonsillitis?

A
  • self care advice +/- PO abx

- swab if persistent / recurrent case

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7
Q

what are the components of the Centor criteria?

A

(+1 for each)

  • age 3-14 (-1 point if >45)
  • temp >38˚C
  • tonsillar exudate
  • cervical lymphadenopathy
  • absent cough
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8
Q

what are components of the FeverPAIN score?

A

(+1 for each)

  • fever in the last 24 h
  • purulent tonsilitis
  • attended within 3 days
  • inflamed severely (tonsils)
  • no cough or coryza
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9
Q

FeverPAIN 0-1

Centor 0-2

A

no abx advised

self care advice

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10
Q

FeverPAIN 2-3

A

“back-up” abx prescription

self care advice

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11
Q

FeverPAIN 4-5

Centor 3-5

A

abx prescription

self care advice

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12
Q

what abx can be prescribed for tonsilitis and for how long?

A

phenoxymethylpenicillin (penicillin V) for 5 days

2nd line / penicillin allergic: Clarithromycin / Erythromycin for 5 days

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13
Q

what are the features of moderate acute tonsillitis?

A
  • unable to freely swallow fluids
  • ‘hot potato voice’
  • clinically unwell
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14
Q

how is moderate acute tonsillitis managed?

A
  • IV abx
  • IV dexamethasone
  • fluids + analgesia
  • bloods + glandular fever screen
  • drain quinsy if present
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15
Q

after moderate acute tonsillitis is managed, what is done next?

A

observe for 3-4 hours, see if pt can tolerate fluids

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16
Q

if the pt with moderate acute tonsillitis can now tolerate fluids after mx, what is done next?

A

discharge home with PO abx and PO steroids

17
Q

if the pt with moderate acute tonsillitis still cannot tolerate fluids after mx, what is done next?

A

continue abx + steroids

ENT referral

18
Q

what are the features of severe acute tonsillitis?

A

airway compromise with trismus → EMERGENCY!

19
Q

how is severe acute tonsillitis managed?

A

Emergency!

  • high flow O2
  • adrenaline nebs
  • IV dex + abx
  • bloods + glandular fever screen
  • anaesthetic and ENT involvement
20
Q

what is Ludwig’s Angina?

A

severe cellulitis involving the floor of the mouth, where swelling develops rapidly → tongue is displaced superiorly and posteriorly, blocking the airway

21
Q

what are the causes of Ludwig’s Angina?

A
  • deep neck space infections
  • dental infection
  • mandibular fracture
22
Q

what are the features of Ludwig’s Angina?

A
  • trismus
  • stridor
  • bilateral neck swelling
  • SOB
23
Q

how is Ludwig’s Angina managed?

A

urgent care with airway mx, IV steroids and abx

severe cases: I+D and intubation

24
Q

what is the role of steroids (dexamethasone)?

A

reduces swelling and inflammation → relieves trismus, allows easier eating and drinking and resolves a ‘hot potato’ voice

25
drooling, stridor and tripod sitting in a toxic looking child. dx?
epiglottitis
26
bilateral cervical lymphadenopathy, fever, myalgia and testicular swelling. dx?
mumps
27
acrid/bitter taste in the mouth while eating, pain in the parotid/submandibular region. dx?
salivary duct stones
28
what is the 1st line ix for acute tonsillitis?
oropharyngeal examination in suspected tonsillitis, pharynx must always be visualised for erythema, swelling and exudate
29
most common bacterial cause of tonisllitis?
strep pyogenes (group A strep)